Differences in Management of Eosinophilic Esophagitis in Europe

Abstract

Objectives: The aim of the study was to assess differences in the diagnosis and management of eosinophilic esophagitis (EoE) by European pediatric (PG) and adult gastroenterologists (AG), and their self-reported adherence to guidelines. Methods: A multiple-choice questionnaire gauged the diagnostic and management strategies of gastroenterologists treating children or adults in 14 European countries and the United Arab Emirates (UAE). Results: Questionnaires were completed by 465 PG and 743 AG. PG were significantly more likely to take biopsies in patients with symptoms of esophageal dysfunction (86.2% PG vs 75.4% AG, P < 0.001) and to perform endoscopic follow-up (86.3% PG vs 80.6% AG, P < 0.001). After failure of proton-pump inhibitors (PPIs), topical steroids were the preferred second-line therapy; however, PG opted more frequently for elimination diets (47.5% PG vs 13.7% AG, P < 0.001). More PG than AG indicated having read recent guidelines (89.4% PG vs 58.2% AG, P < 0.001). Geographic differences in practice were reported, with respondents from the United Kingdom, Portugal, and Spain more often adhering to recommended biopsy protocols. Physicians in the UAE, France, Lithuania, and Poland tended to opt for steroid therapy or elimination diets as first-line therapy, in contrast to most other countries. Conclusions: Significant differences in general practice between PG and AG were demonstrated with notable divergence from consensus guidelines. International practice variations are also apparent. Among other strategies, educational activities to highlight current recommendations may help harmonize and optimize clinical practice.

British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

“…While 89% of paediatric gastroenterologists had read guidelines on EoE, only 58% of adult gastroenterologists had done so. 74 These differences may negatively impact on the outcome of transition from paediatric to adult care.…”

Accurate and timely diagnosis of Eosinophilic Esophagitis improves over time in Europe. An analysis of the EoE CONNECT Registry

“…The reduction in the use of these tests since the publication of Liacouras et al guideline in 2011, in addition to better adherence to the most recent guideline recommendations, could also mean less use of dietary in favor of drug treatment strategies for EoE. The latter are increasingly positioned as the recommended first line treatment in certain environments 44,52 …”

“…The latter are increasingly positioned as the recommended first line treatment in certain environments. 44,52 One of the strengths of our study is the inclusion of a large series of of an international nature, and does not consider the merit that other activities might have in the improvement of EoE care. Among these, the publication of local versions of the guidelines, consensus documents, educational activities developed by scientific organizations, and the role of patient organizations and advocacy groups, 53 must also be recognized as being directly responsible for the changes documented in our study, although their impact is more difficult to measure.…”

“…The latter are increasingly positioned as the recommended first line treatment in certain environments. 44 , 52 …”

Eosinophilic oesophagitis: recent advances and practical management

“…It is unfortunate that the lack of knowledge that EoE is the most common cause of bolus obstruction leads to lengthy delays of therapy and recurrence in many patients. 25 The authors strongly advise biopsy at the index endoscopy to avoid diagnostic failures.…”